FORMULARZ STYPENDIALNY

Stypendia Polskiego Komitetu ds. UNESCO -

finansowane ze środków Ministerstwa Nauki i Szkolnictwa Wyższego

edycja 2015 C w obszarze nauk technicznych

APPLICATION FORM FOR FELLOWSHIP

under the Polish National Commission for UNESCO Scheme -

financed by the Ministry of Science and Higher Education

in Engineering, cycle 2015 C, Annex 03

1. Informacje dotyczące Kandydata/ Background data concerning the candidate

Imię, First and middle names

Nazwisko/ Family name

Obywatelstwo/ Nationality

Data i miejsce urodzenia/ Date and place of birth

Paszport/ Passport number

Adres/ Permanent address and zip code, country

E-mail address:

Wykształcenie/ Education: degrees, diplomas – indicate main subjects

Zawód/ Occupation

Stanowisko obecne, status/ Today status

Referencje dwóch osób, które mogą potwierdzić kwalifikacje kandydata/ References from two persons (titles and address) who can provide information on qualifications of the candidate

1. Instytucja, w której kandydat zamierza odbywać staż; potwierdzenie przyjęcia/ Institution where the studies could be undertaken; Confirmation of admission

AGH University of Science and Technology, Krakow

UNESCO Chair for Science, Technology and Engineering Education  at the AGH University of Science and Technology Krakow, Poland

Confirmation of acceptance from the host institution is imperative:

C. Program stażu, czas trwania, data rozpoczęcia/ Details of proposed studies, duration of research and starting date. If additional space is needed, separate sheets should be attached

UNESCO Interregional Engineering Conferences in Technology and Education - Global Benchmarking and Monitoring, December 10-13, 2015, Krakow, Poland; minimum 10 days stay at the AGH UST Krakow; http://www.ucte2011.agh.edu.pl/

A final report should be sent to the Polish National Commission for UNESCO and to UNESCO AGH Chair not later than one month after return to your country.

Candidate’s signature  ……………………………………………………………

Date: 2015 ………………………….

1. Decyzja Polskiego Komitet ds. UNESCO and UNESCO AGH Chair/ Decision of the Polish National Commission for UNESCO/ UNESCO AGH Chair

..................................................................................................................................

Ważne Informcaje/ Important information:

1. Wniosek Kandydata powinien zawierać / The candidates’ dossiers should include: Formularz stypendialny/ Application Form, życiorys Kandydata ze zdjęciem/ Candidates CV with passport type photo, propozycja artykułu/ paper proposal title, authors data and extended abstract.
2. Facilities offered by the polish authorities: allowance of 1350 PLN (approximately US $450) corresponding to the salary of a local junior research fellow, minimum 10 days stay in Krakow including the UCTE 2015 Conference.
3. Facilities offered by the Candidate themself: International return travel expenses; Health insurance for fellowship beneficiaries; Visa cost.
4. Proszę powiadomić Polski Komitet ds. UNESCO  i  UNESCO AGH Chair o przybyciu do Polski/ Please inform the Polish National Commission for UNESCO and UNESCO AGH Chair about your arrival to Poland: This email address is being protected from spambots. You need JavaScript enabled to view it., This email address is being protected from spambots. You need JavaScript enabled to view it.
5. The application form with all attachments please submit directly to the UNESCO AGH Chair via email This email address is being protected from spambots. You need JavaScript enabled to view it. till November 28, 2015.

Attachments:

File	File size	Downloads
Annex 03 UNESCO AGH Application Form 2015 C.pdf	82 kB	155